updated 10/03/08
Contrast Hydrotherapy
How to use hot and cold water to speed healing from injuries
by Paul Ingraham, Vancouver, Canada (qualifications)
Contrasting is a specific application of hydrotherapy (see Hydrotherapy), which is particularly useful in speeding the healing process from several common injuries, especially plantar fasciitis, ankle sprains, shin splints, carpal tunnel syndrome, and tennis elbow.
Contrasting, or contrast hydrotherapy, involves alternately heating and cooling a body part, or even the whole body. The major purpose of contrasting is to force your nervous and circulatory systems to adapt to the sudden changes in temperature, which is stimulatory, feels great, and has numerous minor benefits.1 It is a powerful way to soothe and stimulate irritated or healing tissue without overstimulating it, and at least some amount of contrasting should be standard part of rehab from most musculoskeletal injuries.
There are many ways to heat up and cool your body parts, and I encourage you to use your imagination and all the tools at your disposal. Here are a few examples.
- Arms are the easiest: a double sink works very well. Fill one with hot water and one with cold and move back and forth. If you only have one sink, it’s often possible to simply switch from a flow of hot water to a flow of cold, especially if it’s a deep sink.
- Lower legs are more difficult. A pair of deep buckets is a bit of work, but very effective. A removable shower nozzle is perfect.
- The thighs or hips are nearly impossible, but I’ve pulled it off using a combination of hot bath with a large bin of cold water used as a sitz bath. Feels great!
- On the body, you can use combinations of heating pads or hot towels with ice gel packs or ice cups (see Icing for Injuries and Tendinitis). These can also be used to good effect elsewhere.
Whatever you come up with, there are just a few rules of thumb to follow:
- Avoid contrasting the freshest injuries that are still hot, swollen, and/or red, because the heat may aggravate the inflammation more than the cooling phase can control. You should use just ice on a fresh injury (note an important exception: back pain is usually not an “injury” per se, and should not be iced). Wait about three days for an injury like an ankle sprain to calm down a bit before you start contrasting it.
- You should apply heat very thoroughly, at least a minute or as long as five minutes depending on how efficient your heating method is.
- If you stretch, stretch after the heating, obviously. If you can, stretch while you are heating. If you have to stop heating to stretch, reheat after stretching before moving on to the cold.
- Always finish every contrast session with cold. Never finish with heat!
- It is desirable (though not always practical) to increase the intensity of the contrast as you go: that is, the hot gets hotter and the cold gets colder. For instance, when I contrast my arms, I start with two sinks of regular hot and cold tap water — but for the second cycle, I dump a little boiling water into the hot, and add a tray of ice cubs to the cold! Thus the 2nd round of contrasting is much more intense.
Is the shower good enough?
To some extent you can contrast in the shower. Whole body contrasting is nice and probably healthful in some general ways, but has limited value for rehabilitating from injuries, which require more intense temperatures, more accurately applied. Immersion of the body part is always the best. Intense heating of only the arm by dipping it in hot water, for instance, tends to cause much greater capillary dilation in the arm than the hottest shower.
The hottest and coldest showers are generally just too hot and too cold to tolerate on large areas of your body … or even just from the splashing if your trying to spray just one part of your body.
A detachable shower head, however, allows you to focus the spray enough to achieve a reasonably good effect.
How much contrasting is enough contrasting?
Precision with dosage of contrasting is not particularly important. Heat and cool in roughly one-minute doses. But if you stick to the idea of “make it good and hot, and then make it good and cold” you’re doing it right. 
And how many times should you cycle between hot and cold? Just a single time — one dose of hot, one dose of cold — is a minimal help. Three times is much more of a help, and is probably a good number. Six times is just tedious! There are practical considerations.
And how many times per day? Roughly once per day. More would undoubtedly be better — perhaps three times per day, for a few days, for a situation where contrasting is particularly easy and ideal for the injury — but there are usually strict practical limits on how much contrasting people can do, or should do.
It’s helpful, but it’s not so good that you should be spending half your day doing it!
This is powerful medicine: don’t underestimate its usefulness just because it sounds a bit odd! Try it, have fun, enjoy the sensation, and rest assured that it is often more effective at helping you heal than virtually any other kind of medication or therapy.
Notes
- Boyle, Wade, and André Saine. Lectures in Naturopathic Hydrotherapy. Sandy, Oregon: Eclectic Medical Publications, 1988. Return to text.
